What is the proportion of medical insurance reimbursement in different places in Shandong Province?

(1) The reimbursement rate for general outpatient service is 50%, and the annual reimbursement for each person is capped in 80 yuan.

(2) Outpatient observation can be reimbursed up to 1 1,000 yuan per day.

(3) The reimbursement rate for outpatient serious illness is 50%, and patients with liver cirrhosis, sequelae of cerebral thrombosis and cerebral hemorrhage, rheumatoid arthritis (active stage), femoral head necrosis, hypertension with complications, diabetes, pulmonary heart disease, systemic lupus erythematosus, aplastic anemia, organ or tissue transplantation anti-rejection treatment, leukemia, severe mental illness, congenital adrenal hyperplasia and congenital hypothyroidism are reimbursed 654.38 million yuan per person per year. Patients with malignant tumor, uremia and hemophilia are reimbursed 30,000 yuan per person per year.

(ii) Hospitalization reimbursement

(1) 200 yuan, the deductible line for hospitalization reimbursement at township level (level 1), with the reimbursement ratio of 85%.

(2) 500 yuan, the deductible line for hospitalization reimbursement of county-level (secondary) designated medical institutions, the reimbursement ratio is 70%.

(3) The deductible line for hospitalization reimbursement of municipal (tertiary) designated medical institutions is 700 yuan, and the reimbursement ratio is 55%.

(4) The deductible line for hospitalization reimbursement in provincial (tertiary) designated medical institutions is 1000 yuan, and the reimbursement ratio is 50%.

(5) With the consent of the county-level new rural cooperative medical management institution, the unified reimbursement deductible line is 1 1,000 yuan, the reimbursement ratio is 40%, and the guaranteed reimbursement ratio is 20%.

(6) The reimbursement rate of drugs, Chinese herbal pieces and non-drug and non-surgical therapies such as acupuncture, massage, cupping and scrapping in the list of essential drugs is increased by 10% on the basis of the original reimbursement rate. The deductible lines of Dezhou City, county-level Chinese medicine hospitals and maternal and child health hospitals were reduced by 200 yuan, and the compensation ratio was increased by 5% on the basis of the original reimbursement ratio.

(7) Proportion of reimbursement for hospitalization expenses of 20 major diseases such as childhood leukemia, congenital heart disease, end-stage renal disease, breast cancer, cervical cancer, severe mental illness, AIDS opportunistic infection, multidrug-resistant tuberculosis, hemophilia, chronic myeloid leukemia, cleft lip and palate, lung cancer, esophageal cancer, gastric cancer, type I diabetes, hyperthyroidism, acute myocardial infarction, cerebral infarction, colon cancer and rectal cancer in designated medical institutions at the municipal and provincial levels.

Further reading: medical insurance cross-provincial settlement Shandong is expected to land this year.

According to the data of Ministry of Human Resources and Social Security, in 20 15 years, the number of urban workers and urban and rural residents seeking medical treatment in different places reached11570,000. At the National People's Social Work Conference held at the end of February, 20 16,65438, Yin Weimin, Minister of Human Resources and Social Security, introduced that in 2016, 30 provinces across the country had achieved card settlement for medical treatment in different places within the province.

Recently, Ministry of Human Resources and Social Security issued a series of documents and held a working meeting to comprehensively start this work.

The reporter found out that in some areas, inter-provincial docking has achieved inter-provincial settlement. Hainan Province, which is in the forefront, has been expanded to 28 provinces (autonomous regions and municipalities) and the 22 1 overall planning area of Xinjiang Production and Construction Corps, and its coverage is leading the country. Xinjiang has settled accounts in different places with Shaanxi, Hainan, Sichuan, Chongqing, Jilin, Zhejiang, Guangdong and Yunnan.

The reporter learned from Ministry of Human Resources and Social Security that at present, the Ministry has started the docking between the provincial medical settlement system and the Ministry of Human Resources and Social Security system. The system "docking between ministries and provinces" will be networked city by city, "one mature and one connected". This also marks the substantive start of the Ministry's public and clear direct settlement of medical treatment across provinces and different places.

At the same time, Ministry of Human Resources and Social Security revealed that the adjustment of the medical insurance drug list has been basically completed. This year, Ministry of Human Resources and Social Security will also revise the measures for the administration of basic medical insurance drugs, and gradually establish a dynamic adjustment mechanism for the drug list.

Medical expenses of individual medical insurance accounts can be transferred to Zigui Medical Insurance Bureau regularly, and hospitals in other provinces should be designated hospitals for local medical insurance.

The reimbursement rate of the threshold fee above 3,000 yuan is 88%, that of 3,000-5,000 yuan is 90%, that of 5,000-10000 yuan is 92%, and that of10000 yuan is 95%, of which 80% is Class B drugs, and 70% is expensive drugs and special examination and treatment.

Procedures required for reimbursement of medical insurance in different places

To seek medical treatment in a different place, you need to go to an outpatient clinic or hospital and issue receipts, lists, prescriptions, details, medical insurance manuals and case diagnosis certificates for related expenses. At the same time, it is necessary to issue the registration certificate of the hospital where the doctor is located, so that the employer, the social security office and the district/county medical insurance center can make statistical summary and audit settlement.

Medical insurance reimbursement process in different places

1. Medical treatment in different places needs to be approved by relevant departments first.

The examination and approval place for resettlement in different places is the county medical insurance center where the insured unit or street social security is located. After applying for the relevant approval form, fill in the relevant contents.

Take the relevant documents to the medical insurance department of a different hospital and stamp them. Then return the relevant approval form to the applicant for approval.

2. The time limit for approval in different places is generally one year.

Specifically, from the date of handling to a certain day in the second year. You can't change it within a year. If the approval period has passed, the parties who are still in different places need to go to the relevant departments for re-approval.

For the parties in different places, it is essential to choose a different hospital. The regulations on how many hospitals patients can choose in different regions are different. Generally, you can choose two or three.

For the medical expenses incurred by the parties in designated hospitals in different places, the relevant reimbursement documents will be mailed back to the original city for reimbursement, or family members can be asked to help reimburse in the original city. Issues such as reimbursement standards will still be in accordance with the regulations of the city, and relevant funds can be collected by family members or related accounts can be set up.

Can the medical insurance card be used in different places?

In many cases, it is necessary to apply to the local social security bureau in advance to use the medical insurance card in different places. Although the current policy has allowed the transfer of medical insurance cards in different places, there is still a geographical gap in the use of medical insurance cards, and the use of medical insurance cards in different places is still limited. It can only be used across regions after approval. As for the specific operation process, it is recommended to consult the local social security center directly! Or call 12333 for consultation and confirmation, subject to their reply.

How to use the medical insurance card in different places?

If you need to use a medical insurance card in other places, you need to take out your money in advance, and then you need to go to the medical insurance center to declare when you return to the local city. This requires a series of proof materials such as proof of drug purchase, including the cost of drugs needed for hospitalization. Medical insurance cards can be used in different places, but the process is more complicated. If the proof materials are incomplete, it will also affect the reimbursement, or even the expenses will not be reimbursed, that is, the medical insurance card has lost its role. But then again, although the medical insurance card can be used, it is also used indirectly. Unlike people's imagination, it is necessary to deduct the handling fee for using the bank card in different places. Using medical insurance cards in different places For some foreign personnel who are hospitalized in different places, if they need to reimburse expenses, they need to pay attention to contact the local medical insurance center in time and collect proof materials according to the tips of the medical insurance center, which will be more convenient.